Neck shoulder and rib pain on right side

Symptoms of thoracic outlet syndrome

Not all people with a cervical rib develop thoracic outlet syndrome, and the syndrome can also be caused by other conditions.

Symptoms of thoracic outlet syndrome include:

• pain in your neck and shoulder, which spreads into your arm – this may be constant or come and go
• temporary loss of feeling, weakness or tingling in the affected arm and fingers
• temporary inability to carry out fine hand movements – such as doing up buttons
• Raynaud's phenomenon – a condition that affects the blood supply to the fingers and toes, turning them white
• a blood clot that forms in the subclavian artery – which can affect the blood supply to the fingers, causing small red or black patches on the skin
• swelling in the affected arm (although this is rare)

These symptoms vary widely from person to person. They may be constant or come and go.

Treating thoracic outlet syndrome

If you have thoracic outlet syndrome, your GP may refer you for physiotherapy. Shoulder exercises can help stretch and strengthen the neck area and correct poor posture. Massage may also help release any tight or shortened neck tissues.

Seeing an occupational therapist may also be useful for advice about techniques to protect your back and neck while at work.

To relieve any pain and swelling, your GP may prescribe a non-steroidal anti-inflammatory drug (NSAID), such as naproxen or diclofenac.

If you develop blood clots you may be prescribed medicines to break them up (thrombolytics), and anticoagulants to prevent further clots developing.

This musculoskeletal condition affects your whole body. When you have fibromyalgia, your brain may process pain signals differently. This could cause you to feel more intense pain. You may also have problems with your bowels, memory, sleep, or mood.

A related, key part of fibromyalgia is the presence of "tender points.” These are areas on your muscles and tendons that are tender when pressed. Typically, tender points are in your neck, back, knee, shoulder, elbow, and hip.

You may also have trigger points with fibromyalgia. These are areas on the muscles around your bones that hurt when pressed. Trigger points may also cause pain or tenderness that you feel in other areas of your body. This is called referred pain. You could have weak muscles, too.

Fibromyalgia Symptoms

Fibromyalgia symptoms may start after you’ve had a physical injury, surgery, infection, or extreme stress. But you may notice symptoms build up over time for no particular reason.

Symptoms may include:

• Muscle pain throughout the body
• Tenderness at certain points
• Pain that:
  • Ranges from mild discomfort to severe enough to limit daily activities
  • Commonly occurs in the neck, upper back, shoulders, chest, rib cage, lower back, and thighs
  • May feel like a burning, gnawing, throbbing, stabbing, or aching
  • Might come on gradually
  • Could seem worse when you try to relax and is less noticeable during activity

• Fatigue
• Sleep disturbances
• Ill feelings like a persistent flu
• Fibro fog, or trouble with mental focus and concentration
• Moderate to severe fatigue
• Sleep problems, including insomnia
• Headaches
• Memory lapses
• Irritable bowel syndrome (IBS)
• Interstitial cystitis or painful bladder syndrome
• Temporomandibular joint (TMJ) disorders

Fibromyalgia Causes

The basic cause of fibromyalgia is still unknown. More than one thing may be involved. Possible causes include:

• Problems in the way your brain and nerves process pain. Experts don’t know what causes this. Nerve stimulation may cause you to have high levels of brain chemicals called neurotransmitters. These chemicals lead to changes in how your brain perceives pain. You may feel painful reactions to mild causes.
• Not getting enough sleep
• Physical or emotional trauma
• Infection or other illness

Fibromyalgia Risk Factors

Risk factors for fibromyalgia include:

• Sex: Experts estimate that at least 5 million American adults have fibromyalgia. Of these, up to 90% are women.
• Family history: Fibromyalgia also seems to run in families, so a gene may be at least partly responsible for the condition.
• Age: Most people with fibromyalgia begin to notice symptoms between the ages of 20 and 40, but children and older adults may also get the condition.

Fibromyalgia Diagnosis

The doctor will give you a physical exam and ask you about your pain and other symptoms. If you’ve had widespread pain for more than 3 months that has no other clear cause, you may have fibromyalgia.

Other tests may help your doctor diagnose fibromyalgia or rule out other causes of your symptoms:

• Tender point exam, where the doctor presses down on 18 specific areas of your body to see if you feel any pain with light touch
• Complete blood count
• Thyroid function test
• Blood tests that check for signs of inflammation. These include:
  • Erythrocyte sedimentation rate
  • Cyclic citrullinated peptide test
  • Rheumatoid factor test

Fibromyalgia Treatment

Medications, exercise, diet, therapy, and self-management can help relieve your fibromyalgia symptoms.

Medications

Several drugs can relieve fibromyalgia pain, improve sleep, or treat other fibromyalgia symptoms:

• Over-the-counter pain relievers, such as ibuprofen, acetaminophen, and naproxen sodium
• Tramadol (Ultram), a prescription pain reliever
• Antidepressants like duloxetine (Cymbalta) or milnacipran (Savella) may ease fibromyalgia pain and fatigue
• Amitriptyline or cyclobenzaprine, a muscle relaxant, may help you sleep
• Gabapentin (Neurontin), an anti-seizure drug, and pregabalin (Lyrica) may ease fibromyalgia symptoms

Therapy

Different types of therapy can help you cope with fibromyalgia or manage your symptoms:

• Physical therapy can help you learn to do exercises, such as workouts in a pool, to improve your stamina, strength, and flexibility.
• Occupational therapy can help you learn new ways to do tasks at work to put less stress on your body.
• Counseling or mental health treatment can help you manage stress and learn to cope with fibromyalgia.

Lifestyle changes

Changes to your lifestyle may ease fibromyalgia symptoms and help you manage your condition:

• Regular exercise like walking, swimming, biking, or stretching can relieve fibromyalgia pain. Stick with your exercise routines and build up your stamina a little at a time.
• Try to get enough sleep at night. Don’t take afternoon naps. Set a regular bedtime and stick to it.
• Find ways to manage your stress. Take time to relax. Deep breathing or relaxation exercises may help. Don’t try to do too much in your daily schedule. It’s OK to say no to some invitations or requests.
• Eat a healthy diet of fresh foods. Keep your caffeine intake low.

Alternative therapies

Some people with fibromyalgia use alternative or complementary treatments to relieve pain or improve their symptoms. These treatments may include:

• Yoga and tai chi, exercises that include gentle movement and breathing to help you relax
• Meditation
• Acupuncture, where a trained practitioner inserts tiny needles into the skin at specific spots to ease pain
• Massage therapy, which may help ease pain and relieve stress